Clinical insight level predicts successful quit or control attempts during the first three months of outpatient addiction treatment.

INTRODUCTION: Low clinical insight in psychiatry is defined as poor recognition of one's mental illness, including disability to self-evaluate symptom severity. It has been reported as common in addiction and is associated with lower treatment compliance. Longitudinal studies suggest that low clinical insight could be linked to more relapse. However, association with successful quit attempts remains unknown. OBJECTIVE: Our objective was to examine the prospective link between baseline clinical insight level and self-reports of successful attempts to quit / control use during the first 3 months of outpatient addiction treatment. METHODS: Participants were recruited from the ADDICTAQUI cohort at outpatient treatment intake for substance or behavioral addictions. They completed a baseline evaluation using the Addiction Severity Index (ASI), the Mini International Neuropsychiatric Interview (MINI), and the modified Hanil Alcohol Insight Scale (m-HAIS) with a follow-up ASI 3 months later. Data were analyzed using multiple logistic regression and non-parametric tests. RESULTS: Lower clinical insight level at baseline was associated with less successful quit / control attempts during the first 3 months of outpatient treatment compared to a higher clinical insight level, controlling for sociodemographic factors, baseline addiction severity, and comorbidities (n = 54; exp(B) = 0.76; p (FDRcor) = 0.033). CONCLUSION: Poor clinical insight may be a barrier to treatment success, and future studies should examine underlying mechanisms.

Continuous theta burst stimulation over the supplementary motor area in refractory obsessive-compulsive disorder treatment: A randomized sham-controlled trial.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a complex disorder with 40 to 60 % of patients resistant to treatment. Theta burst transcranial magnetic stimulation (TBS) is a promising new technique that has been shown to induce potent and long lasting effects on cortical excitability. The present study evaluated for the first time therapeutic efficacy and tolerability of continuous TBS (cTBS) over the supplementary motor area (SMA) in treatment resistant OCD patients using a double blind, sham-controlled design. METHODS: Thirty treatment resistant OCD outpatients were randomized to receive either active cTBS or sham cTBS for 6 weeks (5 sessions per week). Each treatment session consisted of 600 stimuli at an intensity of 70% of resting motor threshold. Patients were evaluated at baseline, at the end of treatment (week 6), and follow-up (week 12). Response to treatment was defined as at least 25% decrease on the Yale-Brown Obsessive Compulsive Scale. RESULTS: There was no significant difference between active and sham cTBS groups in treatment efficacy. Responder rates were not different between the two groups at week 6 (cTBS 28% versus sham 36%; p = 0.686) and week 12 (cTBS 28% versus sham 36%; p = 0.686). Depressive and anxious symptoms improvements were similar in the two groups. CONCLUSION: This study is the first controlled trial using cTBS in treatment resistant OCD patients. The use of cTBS over the SMA is safe but not sufficient to improve OCD symptoms. Further studies are needed to identify the optimal parameters to be used in OCD patients.

The cognitive and neural time course of empathy and sympathy: an electrical neuroimaging study on self-other interaction.

Although extensively investigated in socio-cognitive neuroscience, empathy is difficult to study. The first difficulty originates in its multifaceted nature. According to the multidimensional model, empathy combines emotional, automatic (simulation), cognitive (mentalizing) and regulatory (executive functions) processes. Substantial functional magnetic resonance imaging (fMRI) data demonstrated that co-activations in the mirror neuron system (MNS) and mentalizing network (MENT) sustain this co-recruitment of so-called first- and second-person-like processes. Because of the poor temporal resolution of fMRI techniques, we currently lack evidence about the precise timing of the MNS-MENT combination. An important challenge is, thus, to disentangle how MNS and MENT dynamically work together along time in empathy. Moreover, the role of the executive functions in the MNS-MENT combination time course is still unknown. Second, empathy - feeling into - is closely related to sympathy - feeling with - and both phenomena are often conflated in experimental studies on intersubjectivity. In this electrical neuroimaging (EEG) pilot-study, we tested whether the egocentered vs. heterocentered visuo-spatial mechanisms respectively associated with sympathy and empathy differentially modulate the dynamic combination of the MNS-MENT activations in their respective neural time course. For that, we employed our newly developed behavioral paradigm assessing the visuo-spatial - but not emotional - features of empathy and sympathy. Using a data-driven approach, we report that empathy and sympathy are underlied by sequential activations in the MNS from the insula to the inferior frontal gyrus (IFG) between 63ms and 424ms. However, at 333-424ms, empathy triggered greater co-activations in the right IFG and dorsolateral prefrontal cortex (dlPFC) (executive functions). Linking together our present and prior (Thirioux et al., 2010) findings from the same dataset, we suggest that this greater recruitment of the right dlPFC monitors the shift from egocentered and first-person-like mechanisms in the MNS to heterocentered and second-person-like mechanisms in the left temporo-parietal junction within the MENT, i.e., reflecting the onset of perspective-change processes in the neural time course of empathy. Contrasting with sympathy, this recruitment of the executive functions could modulate the output end of the mirroring processing in the premotor and sensorimotor cortices.